Network Provider for Highmark Blue Cross/Blue Shield, accepting all the Blues, Keystone Blue, Direct Blue, ect., Aetna, Cigna, Medicare, United, accepting all Auto & Work Comp Insurance with verified claim number out of network with UPMC, accepting only PPO & POS plans from UPMC.
Self-Paying Patients and our Time of Service Discount:
Popovich Chiropractic Health Center is pleased to offer EVERYONE (both insured and uninsured) a time of service discount. Our time of service discount is approximately a 15% discount off of many of the services on our standard fee schedule. This discount is available to any and all patients making payment at the time of service (including cash patients and those in-network insurance patients that opt into this plan). Payment can be made via cash or credit card.
Why do we offer this? There are many administrative costs, delays and extra tasks that must be dealt with when processing insurance claims. A patient paying at the time of service greatly lessens this workload which allows us to pass a significant savings on to both the patient (and/or their insurance company). If you are choosing to utilize this discount plan you will need to agree to and sign our ‘Time of Service Discount Program Agreement’ form which is included in the packet we give to all new patients when you arrive at our office.
At the 15% discount level, the most common service prices at our clinic are listed below:
For New Patients:
– A new patient first appointment is around $150-$180
For Existing Patients:
– A typical visit with the chiropractor which includes a spinal adjustment, electric stim., traction, physical therapy and other soft tissue methods: $75
You can be sure our prices are always fair as we use the Physician Fee Schedule from Medicare for Western Pennsylvania.
‘In’ or ‘Out’ of network refers to whether Popovich Chiropractic has a signed agreement with the respective company.
‘Accepting Assignment’ means that we would accept direct payment from an insurance company. A patient is generally only responsible for a copay at the time of service if we accept assignment. If the patient has an UNMET DEDUCTIBLE, they will be required to pay as they go, generally $150-$180 for the 1st visit and $75 for each successive visit until their deductible has been met. Please NOTE, SOME DEDUCTIBLES DON’T APPLY FOR CHIROPRACTIC SERVICES, so its always best to check with your insurer or call our office and have us check if you’re unsure. For example, you may have a $300 deductible under your insurance plan, but it may not apply to chiropractic and some other services and you may only be responsible for your co-pay at the time of your visit. If we do not accept assignment payment is due in full at the time of service.
If you have insurance coverage where we are not an in-network provider, you can contact your insurance company to see if they will reimburse you for visiting an out of network provider. As a general policy, we do not accept assignment from out-of-network insurance companies. This means that you will be responsible for providing payment at the time of service and Popovich Chiropractic can assist you in submitting these charges to your insurance company so they can reimburse you directly. We can provide a superbill with diagnosis and procedure codes directly to you for claim submission. Alternatively, we can send all claim forms directly to your out-of-network insurance on your behalf for free if your insurance company accepts electronic claim submission. This is the extent of the aid we can be expected to give in helping to bill any out-of-network insurance company. If you request that Popovich Chiropractic spend any extra time or effort in the future, in any manner, to assist you in the reimbursement process other than submitting an electronic claim or providing you a superbill, an additional compensation must be paid by the patient to Popovich Chiropractic. Compensation for the additional times spent are at the rate of $25 per hour and $1 per page for medical record printing.
Popovich Chiropractic is currently ‘in-network’ with Blue Cross/Blue Shield, Keystone Blue, Aetna, Cigna, and United . We are also ‘in-network’ with Medicare but this is a special case (see Medicare section below). We will make a copy of your card and collect any CO-pay or portion of UNMET DEDUCTIBLE that is due. We will submit your claims and assist you in any way we reasonably can to help ensure that those claims are paid. Your insurance company may need you to supply certain information to them directly. It is your responsibility to comply with their requests. After hearing back from your insurance company, we will send you a statement if there is a balance that we are entitled to collect. We strongly advise that you contact your insurance company to discuss your benefit coverage for chiropractic services (such as CPT code 98941) and physical medicine services (such as CPT 97110). Knowing your insurance benefits is your responsibility. Insurance coverage for these services varies greatly from plan to plan. We are always happy to help you in determining your coverage but Popovich Chiropractic cannot be held responsible if ultimately the insurance does not pay for services or provides the clinic with false benefit information. Please be aware that some insurance companies require pre-certification for chiropractic care and some may also require a referral from your primary care physician.
*Insurance Deductibles and Co-Payments:
A ‘deductible’ is a prearranged dollar amount on your insurance plan that you must pay out of pocket before your insurance benefits take effect. Portions of UNMET DEDUCTIBLES are collected at the end of each visit (generally $150-$180 for the first visit and $75 for each successive visit) and the patient is billed the difference between the amount collected and the amount billed for the rest until the deductible is met. After the deductible is met or if the plan has no deductible, typically only a co-pay is required for each visit. A ‘CO-pay’ is a payment that Popovich Chiropractic is required to collect at the time of service and is generally listed after the word “specialist” on the front of your insurance card. These arrangements are part of your contract with your insurance company. It is part of our contract with In-Network insurance companies to collect co-payments and deductibles
Medicare patients have very limited insurance coverage at Popovich Chiropractic. Medicare part B has a current yearly deductible of $183. If this hasn’t been met, we ask that this be paid at time of treatment. Medicare does not cover or pay for initial exams even though they require by law that these procedures are performed prior to the beginning of care. Medicare ONLY PAYS FOR CHIROPRACTIC ADJUSTMENTS to the spine and NOTHING ELSE. You will be required to pay for any non-covered services (such as Exams, Physical Therapy, Traction , Stim, and Myofascial Release) but you are entitled to the time of service discount we offer all patients for these services. We do accept assignment for the chiropractic portion of your visit (covered at 80%) but all other services will need to be paid at the time of service. Medicare supplemental insurance may cover the other 20% of the covered Medicare charge but will still not cover Medicare non-covered procedures. If you have a true secondary insurance you may have coverage for other Medicare non-covered procedures though you should be aware that most people do NOT have secondary insurance, supplemental insurance is the much more common type.
*Insurance Non-covered Services and Payment Denial:
Please be aware that depending on the rules outlined by your insurance company, some – and perhaps all – of the services you receive at our clinic may not be covered or deemed medically necessary. Popovich Chiropractic has no way to control this type of judgment by your insurance company. You are responsible for payment of these services and are expected to pay for them in full.
*Insurance and ‘Wellness / Maintenance Care’:
Please note that insurance companies may not pay for wellness / maintenance care. Insurance companies only want to pay for a limited amount of your acute treatment visits with a symptomatic diagnosis. Insurance may also deem care to be unnecessary if therapy is not progressing at what they consider to be a satisfactory rate and will label this as maintenance care. In this case you are entitled to our Time of Service discount if your insurance company refuses payment.
* If my insurance company refuses payment, what happens?
We will gladly work with you and your insurance company to try to rectify any problems that arise. If ultimately the insurance company does not pay, however, you are responsible for your medical bills at Popovich Chiropractic.